HMGT 400 Week 8 Assignment #4 Final Exam

Hospital cost

Question #1 (15 credits):[RStudio Users and Excel Users]

The FINAL EXAM dataset, provides some information about hospitals in 2011 and 2012, download the FINAL EXAM data and then complete the descriptive table. Please answer the following questions.

In term of hospital characters what are the significant difference between 2011 and 2012?
In term of socio-economic variables what are the significant difference between 2011 and 2012?

To report the “Per Capita Hospital Beds to Population”, you need to divide “total_hospital_beds/tot_population)

Based on your findings in which years hospitals had better performance? How hospital performance related to hospital characteristics and socio-economic characteristics? Please write at least three main different movements between 2011 and 2012.

Table 1. Descriptive statistics between hospitals in 2011 & 2012

	2011			2012			p-value
	N	Mean	St. Dev	N	Mean	St. Dev	p-value
Hospital Characteristics
1. Hospital beds		100			150		0.004
2. Number of paid Employee
3. Number of non-paid Employee
4. Internes and Residents
5. System Membership

6. Total hospital cost
7. Total hospital revenues
8. Hospital net benefit

9. Available Medicare days
10. Available Medicaid days

11. Total Hospital Discharge
12. Medicare discharge
13. Medicaid discharge
Socio-Economic Variables
14. Per Capita Hospital Beds to Population
15. Percent of population under poverty
16. Percent of Female population under poverty
17. Percent of Male population under poverty
18. Median Household Income

Question #2 (15 credits): [RStudio Users and Excel Users]

Use the final exam dataset and then answer the following questions:

Compare the following information between for-profit and non-for-profit hospitals.
What are the main significant differences between for-profit and non-for-profit hospitals? Which test is the best fit test? Why?
Use a box-plot and compare Hospital net benefit between for-profit and non-for-profit hospitals.
Show another scatter plot and compare hospital cost (x-axes) and revenue (y-axes) and discuss your findings?
Comparing hospital net-benefit which hospitals has better performance? To answer this question first compute the hospital net benefits with subtracting hospital costs and revenues and then use ttest to compare the significant differences between FP and NFP hospitals.
Overall, what are the main significant differences between for-profit and non-for-profit hospitals?

Table 2. Descriptive statistics between FP & NFP

	For Profit			Non-For-Profit			p-value
	N	Mean	St. Dev	N	Mean	St. Dev	p-value
Hospital Characteristics
1. Hospital beds
2. Number of paid Employee
3. Number of non-paid Employee
4. Internes and Residents
5. System Membership

6. Total hospital cost
7. Total hospital revenues
8. Hospital net benefit

9. Available Medicare days
10. Available Medicaid days

11. Total Hospital Discharge
12. Medicare discharge
13. Medicaid discharge
Socio-Economic Variables
14. Per Capita Hospital Beds to Population
15. Percent of population under poverty
16. Percent of Female population under poverty
17. Percent of Male population under poverty
18. Median Household Income

Question #3 (15 credits): [RStudio Users and Excel Users]

The dataset provides Herfindahl–Hirschman Index for health insurance market, please use the herf_ins variable and answer the following questions:

For this exercise you do not need to compute the HHI, but if you have any questions, please do not hesitate to ask me, but try to learn more about this you will need that to report your findings.

Please remember for the class exercise you used the herf_cat as a hospital Herfindahl index. For this question make sure to use herf_ins as Herfindahl index for insurance market.

Use the final exam dataset and then answer the following questions:

In a short paragraph explain the Herfindahl index you can use the reference provided in the class exercise or any other citation.
Compare the following information between hospitals located in high, moderate and low competitive health insurance markets?
- 1. What are the main significant differences between hospitals in different markets? (use Anova test)
- 2. What is the impact of being in high-competitive health insurance market on hospital revenues and cost?
- 3. Do you think being in high-competitive market has positive impact on net hospital benefits?
- 4. What about the number of Medicare and Medicaid discharge? Do you think hospitals in higher completive market more likely to accept more Medicare and Medicaid patients?
- 5. What is the impact of other variables?

(Note: to answer to the last question, please compute the ratio-Medicare-discharge and ratio-Medicaid-discharge first and then run 2 ttest) high vs. moderate and high vs. low competitive market), please support your findings with box-plot).

Table 3. Comparing hospital characteristics and market

	High Competitive Market			Moderate Competitive Market			Low Competitive Market			ANOVA/Chi-Sq (results)
Hospital Characteristics	N	Mean	STD	N	Mean	STD	N	Mean	STD	ANOVA/Chi-Sq (results)
1. Hospital beds
2. Number of paid Employee
3. Number of non-paid Employee
4. Internes and Residents
5. System Membership

6. Total hospital cost
7. Total hospital revenues
8. Hospital net benefit

9. Available Medicare days
10. Available Medicaid days

11. Total Hospital Discharge
12. Medicare discharge-ratio
13. Medicaid discharge-ratio
Socio-Economic Variables
14. Per Capita Hospital Beds to Population
15. Median Household Income

Question #4 (Credits 20)- [RStudio Users]

Linear Regression Model

If you have chosen to work with RStudio, please run the following model and complete the following tables.

1st Model:

Run a linear model and predict the difference between hospital beds (use the bed-tot) and hospital’s ownership on hospital net-benefit? Discuss your finding, do you think having higher beds has positive impact on the hospital net benefit? What about the ownership?Benefit=F(b0+B1bed+b2Own2+B3ow2+b4own3+e)

	Model 1a
Hospital Characteristics	Coef.	St. Err	p-value
Hospital beds
Ownership
For Profit
Non-for profit	Ref.	Ref.	Ref.
Other
N	Df+K+1
R-Squared

2nd Model:

Now, estimate the impact of being a member of a system on hospital net benefit? And discuss your finding (not more than 2 lines)? Is it significant?

	Model 2
Hospital Characteristics	Coef.	St. Err	p-value
Hospital beds
Ownership
For Profit
Non-for profit
Other
Membership
System Membership
N
R-Squared

3nd Model:

Now, include the ratio of ratio-Medicare-discharge and ratio-Medicaid-discharge in your model? How do you evaluate the impact of having higher Medicare and Medicaid patients on hospital net benefit?

	Model 3
Hospital Characteristics	Coef.	St. Err	p-value
Hospital beds
Ownership
For Profit
Non-for profit
Other
Membership
System Membership
Socio-Economic Characteristics
Medicare discharge ratio
Medicaid discharge ratio
N
R-Squared

Based on your finding please recommend 3 policies to improve hospital performance, please make sure to use the final model for your recommendation.

Discuss your findings.

Question #4 (Credits 20)- [Excel Users]

Linear Regression Model

If you have chosen to work with Excel, please run the models and complete the following tables.

Model 1:

Run a linear model and predict the difference between hospital beds (use the bed-tot) and hospital net-benefit in teaching hospitals?Note: hospital-net-benefit=total_hosp_revenue-total_hosp_costY(benefit), B0+B1(beds)

Hospital Characteristics	Coef.	ST. ERR	T Stat	P-values	Lower 95%	Upper 95%
Model-1
Hospital beds
N
R Square

Model 2:

Run a linear model and predict the difference between hospital beds (use the bed-tot) and hospital net-benefit in non-teaching hospitals?

Use the results from model 1 and model 2 and compare the results between teaching and non-teaching hospitals.

Hospital Characteristics	Coef.	ST. ERR	T Stat	P-values	Lower 95%	Upper 95%
Model-2
Hospital beds
N
R Square

Model 3:

Now, include the ratio of ratio-Medicare-discharge and ratio-Medicaid-discharge in first model? How do you evaluate the impact of having higher Medicare and Medicaid patients on hospital net-benefit in teaching hospitals?

Hospital Characteristics	Coef.	ST. ERR	T Stat	P-values	Lower 95%	Upper 95%
Model-3
Hospital beds
ratio-Medicare-discharge
ratio-Medicaid-discharge
N
R Square

Model 4:

Hospital Characteristics	Coef.	ST. ERR	T Stat	P-values	Lower 95%	Upper 95%
Model-4
Hospital beds
ratio-Medicare-discharge
ratio-Medicaid-discharge
N
R Square

Based on your finding please recommend 3 policies to improve hospital performance, please make sure to use the final model for your recommendation.

Question #5 (Credits 20) [RStudio Users]

If you have chosen to work with RStudio, please run three models and complete the following tables.

Model 1: Run a logit model and use being a member of network and find out its impact on hospital beds and hospital ownership? (Model 1)

Hospital Characteristics	Coef.	St. Err	p-value
Hospital beds
Ownership
For Profit
Non-for profit	Ref.
Other
N
AIC

Model 2: Now, include hospital revenue and report the Coeff.? (Model 2)

Hospital Characteristics	Coef.	St. Err	p-value
Hospital beds
Ownership
For Profit
Non-for profit	Ref.
Other
Hospital revenue
N
AIC

Model 3: Now, include the ratio of ratio-Medicare-discharge and ratio-Medicaid-discharge in your model? And keep all variables you used for models 1, 2 & 3 and discuss your findings? Do you recommend keeping membership for a hospital? Why or why not? (Model 3)

Hospital Characteristics	Coef.	St. Err	p-value
Hospital beds
Ownership
For Profit
Non-for profit	Ref.
Other
Hospital revenue
Medicare discharge ratio
Medicaid discharge ratio
N
AIC

Based on your finding please recommend 3 policies to improve hospital performance in hospitals, please make sure to use the final model for your recommendation.

Question #5 (Credits 20)- [Excel users]

If you have chosen to work with Excel, please run above three models and complete the following tables.

Model 1: Run a regression model and use being a member of network and find out its impact on hospital cost? (Model 1)

Model 2: For the 2^nd model run a regressionmodel and use being a member of network and find out its impact on hospital cost and hospital revenue? (Model 2)

Model 3: For the 3^rd model run a regressionmodel and use being a member of network and find out its impact on ratio-Medicare-discharge and ratio-Medicaid-discharge.

	Coef.	ST. ERR	T Stat	P-values	Lower 95%	Upper 95%
Model-3
Hospital cost
Hospital Revenue
Medicare discharge ratio
Medicaid discharge ratio
N
R Square

Based on your finding please recommend 3 policies and discuss the impact of being on a network on hospital cost, hospital revenue and find out its impact on ratio-Medicare-discharge and ratio-Medicaid-discharge. Do you recommend keeping membership for a hospital? Why or why not?

Question 6: (15 credits) [RStudio Users and Excel Users]

Note: Please limit your answer for each question to maximum 2 paragraphs and make sure to support your findings with at least one citation – following APA 6.

Please offer a research question for the study using human subject research.
Explain the difference between the research process involving human subjects and the research process not involving human subjects.
Discuss ethical implications surrounding human subject research studies.
Explain the governance of the human subject research studies over the data and the process.
Provide examples of the consequences for not meeting IRB (Institutional Review Board) protocol requirements.

Useful formula and guideline.

The computation of the p-value is illustrated in following figures.

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